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HEALTH  AND  EFFICIENCY 


AN  ADDRESS 


BY  THOMAS  DARLINGTON,  M.D. 


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HEALTH   AND  EFFICIENCY 


AN  ADDRESS 


BY 

THOMAS  DARLINGTON,  M.D. 

NEW  YOEK 

SECRETARY,  WELFARE    COMMITTEE,    AMERICAN    IRON    AND    STEEL   INSTITUTE  ;    FORMERLY 

COMMISSIONER    OP    HEALTH    OF   NEW    YORK    CITY  J    MEMBER    OF   THE    AMERICAN 

MEDICAL  ASSOCIATION,  THE  NEW  TOHK  ACADEMY  OF  MEDICINE,  ETC.  ; 

PROFESSOR   OF   SANITARY   SCIENCE,    FORDHAM    UNIVERSITY 


DELIVERED  AT 

THE  BANQUET  OF  THE  AMERICAN  IRON  AND  STEEL  INSTITUTE 

WALDORF-ASTORIA  HOTEL,  NEW  YORK 
MAY  17,   1912 


THE   TROW    P] 


HEALTH   AND   EFFICIENCY. 

Thomas  Darlington,  M.D., 

Secretary,  Welfare  Committee, 

American  Iron  and  Steel  Institute, 

New  York. 

Coincident  with  the  world's  general  progress,  much  has 
been  done  in  recent  years  for  rehef  from  those  conditions 
of  environment  that  affect  us  unfavorably,  for  prevention 
of  disease  and  physical  suffering,  for  the  promotion  of  lon- 
gevity and  happier  conditions.  Such  work  has  made  pos- 
sible the  building  of  the  Panama  Canal,  and  many  other 
great  achievements  which  could  not  otherwise  have  been 
accompUshed. 

Some  Fundamental  Considerations. 

It  is  beginning  to  be  understood  and  soon  will  be  gener- 
ally realized  that  much  effort  has  been  wasted  in  the  past 
and  much  efficiency  has  been  lost  by  lack  of  attention  to 
industrial  hygiene.  Matters  of  this  kind  have  been  re- 
garded as  philanthropic,  and  therefore  not  to  be  considered 
in  connection  with  business  enterprise.  As  the  business 
transactions  of  the  world  have  for  their  object  profit,  any 
proposal  is  measured  by  finance.  While  the  inspiration  for 
the  betterment  of  working  conditions  may  have  arisen  from 
physicians  and  philanthropists,  true  economy  has  played  a 
large  part  as  the  ultimate  cause  of  sanitary  reform  and  will 
continue  to  do  so. 

That  it  pays  to  safeguard  a  workman  from  loss  of  limb 
or  other  accident  by  covering  gears  or  placing  guard-rails 
about  pulleys  and  belts  is  a  conclusion  that  is  obvious. 
Nevertheless  until  recent  years  but  little  had  been  done. 
Not  so  obvious  but  just  as  far  reaching  in  its  results  is  the 
safeguarding  of  employees  against  disease. 

It  is  axiomatic  that  efficiency  depends  on  health. 

It  is,  therefore,  of  great  commercial  importance  that 
workmen  be  surrounded  with  proper  safeguards  not  only  for 


4  AMERICAN   IRON   AND   STEEL   INSTITUTE,  MAY   MEETING 

the  prevention  of  accidents  but  also  for  the  prevention  of 
sickness,  and  that  everything  practicable  be  done  not  only 
to  prevent  disease  but  also  to  raise  the  standard  of  health 
to  the  highest  point. 

The  health  of  any  community  depends  on  the  health  of 
its  individual  components.  It  depends  therefore  on  the  per- 
sons themselves,  on  those  responsible  in  various  degrees  for 
the  daily  hfe  and  work  in  a  community,  and  upon  those  who 
are  responsible  for  the  making  and  enforcement  of  laws. 

So  the  responsibility  may  be  divided  under  three  heads : 

1.  Personal  hygiene  or  care  by  employes  of  themselves; 

2.  Care  by  a  company  within  its  inclosure; 

3.  Care  by  authorities  (town,  city,  state  and  national 
Government)  in  making  and  enforcing  of  laws. 

While  public  hygiene  can  be  enforced,  personal  hygiene 
is  a  matter  that  must  largely  be  the  result  of  education. 

Personal  Hygiene. 

The  care  of  the  individual,  those  things  which  are  largely 
under  his  control  and  which  he  should  do  for  himself  are: 
The  regulation  of  his  meals — the  amount,  character,  and 
mastication  of  them;  the  amount  and  character  of  drink; 
hoiu-s  of  rest  and  sleep;  ventilation  of  rooms;  personal 
cleanliness,  for  clean  bodies  and  clean  clothes  lessen  the 
chances  of  blood  poisoning  in  accident  cases;  washing  of 
hands  before  meals;  daily  washing  of  feet;  proper  fitting 
of  shoes;  amount  and  kind  of  clothing,  care  of  the  eye,  ear 
and  nose;  brushing  of  teeth;  regularity  of  habits ;  the  cul- 
tivation of  cheerfulness — for  the  mind  has  much  to  do  with 
the  body  and  especially  with  tissue  changes  and  secretions; 
regularity  of  work. 

The  first  condition  of  health  is  fruitful  toil.  Work  is 
not  a  necessary  evil;  it  is  our  greatest  safeguard  against 
disease  and  advancing  old  age. 

The  individual  should  be  taught  that  definite  results 
are  to  be  obtained  from  definite  conduct. 

It  has  frequently  been  asserted  that  a  large  percentage  of 
accidents  occurring  about  plants  are  due  to  fatigue.  From 
observation  and  inquiry  it  would  seem  that  the  greatest 


HEALTH   AND   EFFICIENCY — DARLINGTON  5 

number  of  accidents  are  due  to  carelessness,  some  to  ig- 
norance, some  to  alcoholism,  and  other  cases  to  a  lack 
of  proper  guarding  of  machinery.  Still  fatigue  must  be 
considered. 

The  determinations  of  physiologists  show  that  constant 
and  rapid  motion  of  a  muscle  produces  fatigue  by  the  accu- 
mulation of  lactic  acid  and  carbon  dioxide  within  it. 

It  is,  however,  reasonable  to  suppose  that  fatigue  is  due 
not  alone  to  accumulation  of  acid  within  muscles  but  also 
to  a  lack  of  carbohydrates  caused  by  improper  feeding,  or  to 
excess  of  alcohol,  or  to  deranged  metabolism — due  to  lack 
of  oxygen,  or  to  loss  of  sleep,  or  the  condition  of  the  skin,  or 
the  amount  of  fluid  taken,  or  as  the  result  of  putrefaction  in 
the  intestines  and  the  formation  of  certain  aromatic  bodies 
and  absorption  of  them  in  the  system. 

If  this  be  true,  what  a  field  of  effort  is  opened  to  us  for 
the  study  and  correction  of  such  conditions;  how  easily  we 
see  that  loss  of  efficiency  can  be  connected  with  matters  of 
personal  hygiene — how  great  the  importance  to  both  em- 
ployer and  employee  of  education  in  such  matters. 

Sanitation  by  Employing  Companies. 

Under  the  second  head  come  those  matters  relating  to 
health  that  should  be  worked  out  within  the  plants.  Among 
these  may  be  mentioned  periodic  physical  examinations  of 
employes  ;  furnishing  a  wholesome  supply  of  drinking 
water,  with  regulation  of  its  temperature  and  method  of  dis- 
tribution; adequate  washing  facilities;  a  sufficient  number 
of  properly  constructed  clean,  light  and  well  ventilated 
toilets;  proper  sewage  disposal;  good  ventilation  with  pre- 
vention of  fumes,  dust  and  smoke,  or  proper  disposition  of 
them;  clean  floors  and  yards;  proper  methods  of  heating 
in  winter  and  cooling  appliances  for  heated  work-places  in 
summer;  good  lighting;  provision  for  first  aid;  and  pos- 
sible consideration  of  lunch  and  rest  rooms. 

Among  questions  cognate  to  these  are  problems  relating 
to  hours  of  labor  and  periods  of  rest. 

In  many  plants  such  matters  as  these  have  already  been 
taken  up  with  those  in  charge.     In  the  building  of  plants  it 


6  AMERICAN   IRON   AND    STEEL   INSTITUTE,  MAY   MEETING 

is  well  to  keep  these  things  in  mind,  for  if  included  in  con- 
struction their  cost  would  be  less  than  if  added  later. 

I  cannot  too  strongly  urge  that  when  money  is  available 
for  welfare  or  sanitary  work  it  be  spent  first  for  the  purposes 
just  enumerated,  rather  than  for  the  building  of  club  houses 
or  reading  rooms,  or  for  lectures,  playgrounds,  recreation 
centers,  planting  of  trees,  flower  gardens,  or  visiting  nurses. 
For,  while  these  are  all  desirable  in  themselves  and  appeal  to 
the  general  pubhc,  they  are  not  by  any  means  of  first  import- 
ance. Nor  should  the  money  be  expended  for  the  correc- 
tion of  town  or  city  conditions,  because  these  things  should 
be  the  care  of  the  body  pohtic,  the  community  as  a  whole. 

Furthermore,  one  must  keep  in  mind  that  work  of  such 
character  must  be  Hmited,  that  too  much  paternaUsm  is 
unwise  and  against  pubhc  pohcy.  What  these  limits  are 
only  the  future  can  decide.  At  present  the  first  considera- 
tion of  each  company  should  be  the  safety  and  health  of 
the  workmen  within  its  plant. 

Sanitation  Under  Public  Authority. 

This  brings  us  to  the  third  heading,  the  making  and  en- 
forcing of  sanitary  laws  by  pubhc  authorities — the  subject 
of  this  evening's  paper. 

A  healthy  organism  can  largely  adapt  itself  to  its  sur- 
roundings, whether  in  the  Arctic  Circle  or  at  the  Equator; 
but  it  cannot  adapt  itself  to  bad  milk  from  diseased  cattle, 
impure  food,  polluted  water,  dirty  streets,  putrid  garbage, 
fly-breeding  manure  heaps,  mosquitoes,  bad  drainage, 
crowded  sleeping  rooms,  foul  air,  and  contagion. 

The  regulation  of  such  conditions  is  chargeable  not  to 
employer  or  employe,  but  to  the  city,  town  or  state  as  a 
whole.  Such  matters  are  as  much  the  care  of  the  pubhc  as 
are  schools,  fire,  or  police,  and  they  should  not  be  left  to 
the  haphazard  of  charity.  Nor  should  they  be  left  entirely 
to  those  whose  duty  it  is  to  enforce  the  laws.  These  officials 
are  ofttimes  absolutely  dependent  for  their  daily  bread  upon 
the  persons  over  whom  they  are  called  upon  to  exercise 
authority,  with  the  result  that  the  laws  are  but  indifferently 
administered. 


HEALTH   AND   EFFICIENCY — ^DARLINGTON  7 

The  losses  entailed  are  largely  calculable.  When  we 
consider  the  loss  in  wages,  loss  of  time  in  school  and  cost  to 
the  State  from  lack  of  promotions,  sickness  in  hospitals, 
drugs,  doctors,  nurses,  undertakers,  the  effect  on  the  family 
from  the  loss  of  the  father,  the  wage  earner,  and  a  host 
of  things  too  numerous  to  mention  here,  the  economy 
of  h3''gienic  measures  becomes  apparent.  But  who  shall 
measure  the  loss  in  efficiency  of  a  workman  if  a  member  of 
his  family  is  ill  and  his  mind  is  not  upon  his  work?  How 
much  also  has  this  mental  abstraction,  due  to  anxiety,  to  do 
with  accidents? 

After  long  and  careful  study,  I  find  that  the  proper 
standard  of  health — and,  therefore,  efficiency — cannot  be 
maintained  in  the  iron  and  steel  and  allied  industries  be- 
cause of  the  lack  of  proper  laws  and  the  inadequate  enforce- 
ment of  existing  laws  by  National,  State  and  local  authori- 
ties. Enormous  sums  of  money  are  paid  in  taxes  for  which 
there  is  no  adequate  and  proper  return. 

Health  Departments  are  never  fully  equipped.  Very 
few  deserve  the  name,  and  some  are  simply  a  name.  In  the 
past,  and  even  to-day  in  the  majority  of  places,  matters 
which  pertain  to  pubhc  health  and  to  hospitals  have  been 
and  are  largely  matters  of  private  charity. 

Some  Significant  Figures. 

Death  rates  are  falling  wherever  the  mandates  of  hy- 
giene and  sanitary  science  are  obeyed.  While  in  many 
places  much  has  been  accomplished,  other  places  are  still  in 
the  condition  of  sanitation  prevalent  thirty  years  ago. 

A  study  of  causes  of  death  shows  that,  in  general,  but 
4%  die  from  old  age,  4%  more  from  violence,  while  92% 
die  from  disease.  Of  this  last  great  group,  nearly  one  half 
are  due  to  diseases  of  environment;  that  is,  to  diseases 
which  are  the  concern  of  health  authorities,  diseases  which 
by  proper  supervision  could  be  wholly  eliminated.  There 
is  no  necessity  for  deaths  from  typhoid  fever,  tubercu- 
losis, or  diseases  of  like  character.  They  are  wholly  pre- 
ventable. 

The  determination  of  the  health  necessities  of  communi- 


8  AMERICAN   IRON   AND    STEEL   INSTITUTE,  MAY   MEETING 

ties  is  based  principally  on  the  death  rates  and  general 
inspection.  Taking  fifteen  of  the  principal  towns  visited 
for  the  Institute,  excluding  the  large  cities,  the  death  rates 
averaged  19  per  1000 — easily  double  what  it  should  be  and  at 
least  one  third  more  than  the  rate  of  some  cities  of  larger  size. 

For  instance,  Minneapolis  with  over  300,000  population 
has  a  death  rate  of  8.63  per  1,000,  and  even  New  York  and 
Chicago  with  their  dense  and  heterogeneous  population  have 
death  rates  of  only  15.1  and  14.5  per  1,000,  respectively. 

The  basis  of  sanitary  work  is  registration  of  vital  sta- 
tistics. In  not  one  state  in  the  Union  is  there  a  complete 
registration  of  births,  and  fully  one  half  of  the  country  has 
no  registration  of  deaths. 

Importance  of  Milk  Supply. 

Of  the  matters  that  need  remedying  by  the  authorities, 
certain  things  stand  out  more  prominently  than  others.  That 
which  is  pre-eminent — so  far  as  it  affects  the  growth,  health 
and  life  of  children  in  the  home — is  the  condition  of  the  milk 
supply. 

This  is  a  matter  of  vital  importance.  Not  alone  does  it 
affect  children,  but  it  stands  second  as  a  cause  of  typhoid  in 
adults.  And,  although  the  agitation  for  supplies  of  clean 
and  wholesome  milk  has  been  going  on  throughout  the 
country  for  several  years,  in  many  places  nothing  has  yet 
been  done. 

In  a  number  of  towns  where  the  industries  connected 
with  the  Institute  are  located  I  have  had  occasion  to  visit 
some  of  the  principal  sources  of  milk  supply  and  have  found 
that  they  could  hardly  be  worse.  In  cities  advanced  in 
matters  pertaining  to  health,  it  is  usual  to  mark  the  standing 
of  dairies  upon  a  score  card  on  the  basis  of  100.  Using 
such  a  card,  some  of  the  dairies  visited  scored  8  or  10, 
others  2  or  3,  and  to  some  I  was  unable  to  give  a  single  point. 

Neglect  of  Contagious  Diseases. 

Again,  among  children  it  is  noticed  that  the  death  rates 
from  contagious  and  communicable  diseases  are  high.  It 
has  been  shown  by  records  that  such  diseases  are  largely 


HEALTH   AND    EFFICIENCY — DARLINGTON  9 

spread  through  the  medium  of  pubhc  schools.  The  ap- 
proved method  of  control  of  such  a  condition  is  by  a  system 
of  medical  school  inspection  and  proper  quarantine  and  dis- 
infection, and  the  reporting  of  cases  by  physicians.  But 
such  a  thing  as  medical  school  inspection  is  almost  un- 
known, except  in  a  few  large  cities,  and  even  there  it  is  not 
practiced  to  its  fullest  extent,  while  quarantine  and  disin- 
fection are  largely  left  to  the  family  physician. 

In  many  instances,  cases  of  contagious  disease  have  no 
physician  and  are  not  reported  at  all,  thus  giving  oppor- 
tunity for  the  spread  of  disease  to  others. 

Little  or  no  provision  has  been  made  for  proper  care  of 
contagious  disease  among  adults. 

Contagious  disease  hospitals  are  lacking  everywhere. 
In  two  places  visited  it  was  noticed  that  school  houses  cost- 
ing more  than  $125,000  each  had  been  erected,  but  at  each 
place  the  contagious  disease  hospital  (or,  as  they  properly 
term  it,  ''the  pest  house")  cost  only  about  $125. 

Further  study  of  death  rates  shows  that  the  mortality 
from  tuberculosis  and  other  diseases  of  the  lungs  is  high. 
It  takes  but  little  investigation  and  study  to  find  the  prin- 
cipal causes.     Among  these  is  foul  air. 

Crowding  of  Sleeping  Rooms  Should  Be  Abolished. 

Crowded  sleeping  rooms  are  found  everywhere.  It  is 
conceded  by  sanitarians  that  the  least  possible  space  for 
each  person  in  sleeping  apartments  shoilld  be  400  cubic  feet, 
and  the  air  should  be  changed  hourly;  yet  almost  every- 
where workmen  were  found  occupying  much  less  space, 
frequently  less  than  half  that  amount — with  no  windows 
open  and  no  system  of  ventilation,  with  beds  often  continu- 
ously occupied  by  the  interchanges  of  day  and  night  shifts, 
those  working  at  night  taking  the  place  in  bed  occupied  by 
those  that  work  in  the  day  and  conversely. 

Metabolism — that  is,  the  body  processes  and  chemical 
changes  that  take  place  in  the  tissues — cannot  be  properly 
carried  on  under  such  conditions,  especially  the  oxidative 
processes.     So  a  lack  of  fresh  air  and  the  breathing  of  ex- 


10         AMERICAN   IRON   AND    STEEL   INSTITUTE,  MAY   MEETING 

pired  air  in  sleeping  rooms,  unfit  a  man  for  work.  They 
cause  a  loss  of  vigor,  lowered  vitality,  loss  of  appetite,  ane- 
mia, and  loss  of  resistance  to  disease. 

Recent  physiological  research  shows  that  under  such 
conditions  the  body  may  not  get  rid  of  its  heat,  a  feverish 
condition  thus  supervenes,  and  there  is  a  consequent  waste 
of  fuel. 

These  crowded  and  ill- ventilated  rooms  were  frequently 
found  in  the  back  of  saloons  or  above  them.  Many  work- 
men, in  their  desire  to  save,  choose  to  board  at  such  places, 
because  board  is  furnished  at  the  low  rate  of  $3.50  per  week. 
With  the  present  high  cost  of  living,  this  appeals  strongly 
to  the  single  laborer,  and  the  saloon  makes  its  profit  from 
the  sale  of  intoxicants.  The  combination  of  alcohol  and 
foul  air  readily  accounts  for  disease. 

In  diseases  of  such  character,  early  diagnosis  is  of  prime 
importance.  In  lung  diseases,  the  sputum  must  be  exam- 
ined microscopically.  In  the  larger  cities  this  is  done  by  a 
bacteriologist  at  the  expense  of  the  City.  The  bacteriol- 
ogist in  connection  with  the  Health  Department  diagnoses 
not  only  tuberculosis,  but  also  diphtheria,  typhoid  and 
malaria.  Such  assistance  is  needed  everywhere,  but  it  is 
almost  universally  lacking. 

Better  Municipal  Water  Supplies  Are  Needed. 

In  a  large  percentage  of  the  plants,  and  in  towns  con- 
trolled by  the  industry,  the  drinking  water  supplies  belong 
to  the  Companies  themselves,  and  care  has  been  taken  to 
purify  and  protect  such  supplies.  But  in  many  of  the  towns 
visited,  the  town  water  was  found  polluted,  and  in  others 
the  water  so  unattractive  by  the  amount  of  turbidity  due  to 
the  mud  and  silt  it  contained,  especially  during  the  spring 
freshets,  that  it  was  useless  even  for  washing,  not  to  men- 
tion drinking  purposes. 

Inasmuch  as  typhoid,  diarrhoea  and  dysentery  are 
largely  spread  by  polluted  water,  the  necessity  for  better 
municipal  water  supplies  is  obvious. 

Garbage  is  generally  not  collected  and  fly-breeding  stable 
manure  is  permitted  to  be  heaped  up  beside  stables  and  in 


HEALTH   AND    EFFICIENCY — DARLINGTON  11 

back  alleys  throughout  the  year.  Many  towns  are  without 
sewers.     Very  few  have  any  system  of  sewage  disposal. 

In  a  number  of  places  where  there  are  no  sewers,  cess- 
pools take  their  place.  These  are  connected  with  limestone 
caverns,  and  no  one  knows  where  the  sewage  goes.  It 
frequently  happens  that  a  neighbor  pumps  it  up  as  well 
water. 

So  I  repeat,  not  only  conditions  surrounding  the  man 
when  he  is  at  work  must  be  guarded,  but  also  those  condi- 
tions surrounding  him  when  away  from  work.  Of  what 
avail  is  the  furnishing  of  wholesome  water  to  the  man  when 
at  the  plant  if  he  must  take  a  polluted  supply  when  he 
returns  to  his  home. 

SUMMAKY. 

Thus  I  might  go  on  enumerating  the  various  sanitary 
undertakings  resting  as  a  duty  upon  cities,  towns  and  vil- 
lages; but  the  instances  I  have  given  are  enough  to  show  the 
necessity  for  action.  As  large  taxpayers  those  who  manage 
and  control  plants  should  exercise  their  prerogative  in 
demanding  that  public  authorities  perform  their  proper 
functions  in  promoting  the  health  and  happiness  of  the 
people. 

Summarized,  these  duties  well  performed  mean  pure  air, 
wholesome  water,  an  uncontaminated  food  supply  and  relief 
from  those  factors  that  detract  from  physical  comfort. 
They  mean  better  work  accomplished  and  thus  economy  to 
employing  companies  by  increased  industrial  efficiency. 
They  mean  decreased  loss  of  time  due  to  preventable  illness. 
They  mean  decreased  death  rate  from  preventable  diseases. 
They  mean  prevention  of  the  spread  of  communicable  dis- 
eases. They  mean  betterment  of  living  conditions.  And 
finally,  they  mean  contented  workmen — and  contentment 
is  greatly  to  be  desired. 


COLUMBIA  UNIVERSITY 

'J'his  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

i 

1 

1 

CZ8'63a)Meo 

1 

RA436 
Darlington 


D24 


